Pathology Competencies in Medical Education and Educational Cases: Update 2023

Pathology is a core component of medical school curricula because understanding the pathogenesis of the disease is foundational both for diagnostic efficiency and optimal use of ancillary resources in patient care. The Pathology Competencies for Medical Education (PCME) were developed as a national resource of expectations of pathology knowledge for medical students. The PCME are composed of three competencies: disease mechanisms and processes, organ system pathology, and diagnostic pathology and therapeutic pathology. The learning goals and learning objectives of the PCME that were first published in 2017 have been carefully revised and updated. Significant additions were made to fill gaps of the original PCME objectives, and some learning objectives have been retired or moved to more appropriate locations within the competencies. As curricula and the practice of medicine change, the PCME will continue to be revised and updated periodically. They have and will continue to serve as the organizing principle for the growing number of educational cases published by Academic Pathology. Nomenclature in the original and revised PCME will allow for continued linking of previous and new educational cases to the revised learning objectives. PCME and the educational cases can be adapted into any type of curricula. Having a widely accepted resource of learning objectives in pathology will help students and medical educators focus on essential components of pathology for the future practice of medicine.


Introduction
A great shift in medical school curricula has occurred in the past 10 to 15 years from course-based curricula to integrated organ system-based curricula. This shift has allowed medical students to enter clerkships earlier and increase their clinical exposure. However, practicing medicine today, perhaps more than ever, requires a broad knowledge of normal and pathological processes. The rapid increase in the number of available laboratory tests, most notable in the explosion of genetic testing, makes it even more important for practicing physicians to have a solid understanding of mechanisms of disease, both to choose the most appropriate laboratory test(s) and to counsel their patients about their meaning. This project began approximately 10 years ago as a working group of the Association of Pathology Chairs (APC), which developed an initial set of pathology competencies described in "National Standards in Pathology Education." 1 In this initial publication, over 60 pathology course directors and pathology chairs submitted course objectives that were extensively reviewed and, in 2014, posted on the APC website. To further disseminate these learning objectives, the APC published a revision of them in Academic Pathology in July 2017 as the Pathology Competencies for Medical Education (PCME). 2 The objectives are placed within one of three competencies: (1) Disease Mechanisms and Processes, (2) Organ System Pathology, and (3) Diagnostic Pathology and Therapeutic Pathology.
Just prior to its annual meeting in 2018, the APC sent a survey to its members to evaluate the impact of the PCME and to assess the extent to which these had been implemented in curricula. Forty-nine members from 48 different institutions responded to the survey. Of the responders, 42 (86%) responders indicated that they had read the PCME and 29 (59%) responders indicated that they had used information from the PCME to change, modify, or update the learning objectives at their own institution. Comments received indicated that members had altered lectures to align with the PCME; updated course content and/or learning objectives; mapped their own institution curriculum on to the PCME. Others found out about the PCME from the survey and indicated that they now plan to use them. Some responders commented that the PCME should be vetted nationally with other national society buy-in, and a rare comment mentioned that the objectives were too dense. Sixteen (34%) of responders indicated that the PMCE were useful in other ways, such as to negotiate for more time with institutional leadership, to develop 4th year electives, to map curriculum, to re-affirm what pathology course directors are teaching, and to add diagnostic medicine to the curriculum. There were also some suggestions for additions to fill gaps in objectives, including interstitial lung disease, head and neck (HN) pathology, multisystem disease and amyloidosis, urinalysis, and chemistry (CHEM). This current revision is an attempt to address the previous comments and the gaps in the PCME and to provide a more uniform and updated set of competencies for educators to use in undergraduate medical education (UME).

Methods
Since the first publication of the PCME in 2017, there have been many opportunities for comments of the learning objectives. In addition to the formal survey noted above, faculty have provided direct input to the authors of the PCME and sessions have been devoted to the PCME at conferences. Many authors who have submitted educational cases have commented on the PCME; in turn, the editors of the educational cases identified gaps when reviewing submitted cases. We have taken the comments from these many sources and have systematically reviewed, reorganized, and revised the PCME. In order to decide whether an objective merited inclusion we used standard pathology textbooks and a recent comprehensive reference to assess whether information was necessary to include. [3][4][5] As Fig. 1 illustrates, the revision of the PCME is a cyclic process that includes incorporation of comments from constituents through multiple processes mentioned above.
We have removed redundancies and made some significant shifts in several topic areas so that the learning objectives are more appropriately aligned with the 3 major competency areas. We also added significant amounts of new content. For example, in genomics, several mechanistic objectives in competency 3 were moved to competency 1. In hematopathology, pathophysiologic objectives formerly in competency 3 were moved to competency 2; diagnostic objectives are now collected in competency 3. To fill gaps, we sometimes introduced brand new learning goals, such as those representing vascular disorders, multisystem disease, or HN pathology; other gaps were filled by adding objectives within an existing learning goal. Competency 3 was significantly revised to expand the CHEM and the transfusion sections; learning objectives throughout this competency are now focused more specifically on diagnostic testing. Finally, several learning objectives have been retired because they either did not fit with current pathology teaching or duplicated other learning objectives.
The nomenclature of the original learning objectives has been retained, and notes have included to indicate any change from the prior PCME edition. If a learning objective was moved to a different competency, we have used the nomenclature "C" for competency along with the prior learning goal and objective to indicate its origin. For example: "Objective GM1.7 (Formerly C3, GE1.4): Linkage Analysis. Outline the principles that underlie genetic linkage analysis and association studies and how they are used to identify genes associated with diseases." This learning objective of linkage analysis is now objective GM1.7 in competency 1 under genetic mechanisms (GMs), and was moved from competency 3, GE 1.4, genomics.
We hope this nomenclature will allow continued easy cross reference for both prior and current learning objectives to allow for consistent mapping of any previously published educational case attached to an earlier learning objective. Publication in Academic Pathology ensures wide access to the revised learning objectives.

Discussion
The PCME were originally designed to represent the minimum knowledge thought necessary for medical students to practice in medicine today. Through the revisions of the PCME, we have retained the three major competencies under which the learning objectives are now better aligned. These objectives are broad and comprehensive and can be applied to different curricula, whether in a free-standing course or adapted into the current model of integrated teaching. While relevant to a comprehensive pathology curriculum, we acknowledge that not all learning objectives need to be taught by pathologists. We hope that having peer-reviewed learning objectives as a national resource will encourage pathology educators to adapt some or all into their curricula or to refine their own learning objectives. As confirmation that a foundational understanding of pathology continues to be central to UME, approximately 50% of the questions in the United States Medical Licensing Exam (USMLE) Step 1 assess pathology material. 6 In addition to integrated curricula, some medical schools have shifted to competency-based medical education by endorsing Entrustable Professional Activities (EPAs). Several of the EPAs developed by the Association of American Medical Colleges tie directly to the foundational understanding of pathology. These include EPA 3 "Recommend and Interpret common diagnostic and screening tests"; EPA 2 "Prioritize a differential diagnosis following a clinical encounter"; EPA 9 "Collaborate as part of an interprofessional team.". 7 In addition, the third pillar of medical education, Health System Science (HSS), 8 requires an understanding of the important role pathology plays to ensure safe, equitable, timely, and efficient patient care. This will lead to an increase in efficient use of laboratory testing and an increase of patient safety. Publications integrating HSS curriculum in UME include a 2016 publication from the American Medical Association describing the domains of HSS education. 9 While the learning objectives are designed as free-standing statements to capture the breadth and depth of necessary content in pathology, one of their major uses has been as an anchor for the development of educational cases. These are succinct peer-reviewed clinical case presentations that lead the reader through clinical reasoning to determine a differential diagnosis based on history, physical examination, and laboratory findings. The educational cases all have a primary learning objective and may have additional secondary learning objectives. An educational case focused on basic pathobiology would typically have a primary C1 learning objective, one focused on organ system pathology C2, and one on laboratory diagnosis of disease C3. Most cases have multiple objectives; the primary learning objective should be fully discussed in the educational case, but secondary learning objectives do not need full discussion. Teaching points at the end of each case discussion provide the key learning points of the primary learning objective and secondary objectives if used.
The repository of educational cases that accompany the PCME continues to grow by approximately 40 new cases per year. Currently, 169 have been published in Academic Pathology; additional cases are in production. Educational cases comprise 4 of the top 10 articles downloaded from Academic Pathology in 2022. In addition, 9 of the top 10 accessed publications from Academic Pathology in PubMed Central® are educational cases. We encourage authors to continue to submit educational cases, especially in the areas of new and revised learning objectives. Cases can easily be adapted into many different types of learning settings, including laboratories, small group discussions, and team-based learning exercises. The cases emphasize the use of clinical reasoning to devise a differential diagnosis and provide increasing amounts of information to the learner to refine a differential and arrive at a final diagnosis. The discussions that accompany the cases emphasize the clinical reasoning behind the conclusions and should fully explain all aspects of the primary learning objectives. By incorporating clinical, laboratory, and pathophysiologic information, these exercises help undergraduate medical students develop the critical thinking skills they will need as practicing physicians. With the nomenclature system developed for the PCME, educators can search for cases meeting specific objectives using the spreadsheet on the APC website. 10 The linkage between previous versions and this revision will allow them to find cases written under a previous leaning objective that was moved or retired.
While medical educators are the primary audience of the PCME and the educational cases, students can also use the cases for study, review, and expansion of knowledge. While not designed to reflect what every student must master before beginning a residency, the PCME can serve as a checklist for students to follow as they learn the breadth and depth of pathology; the educational cases provide vehicles for them to see how that knowledge is applied.
The most extensive changes in this revision are to the third competency on diagnostic medicine. A previous report indicated that nearly all inpatient care, just over half of emergency room visits, and about one third of outpatient visits result in laboratory testing, 11 underscoring the need for all medical students to understand laboratory medicine. We now include many new learning objectives in this competency, and its focus is now clearly to equip the medical student with a broad understanding of laboratory testing. Knowing when and how to order tests (including appropriate diagnostic use of tissue samples), what information they provide, and how disease processes produce the abnormalities detected all will help future physicians provide cost effective and efficient patient care. A recent publication highlighting the most common laboratory tests and the pathophysiology underlying changes in their values has been linked to the PCME. 5

Conclusion
The revised PCME highlight three major competencies in pathology, namely disease mechanisms and processes, organ system pathology, and diagnostic medicine and therapeutic pathology. The revisions have addressed gaps in the original PCME publication and reorganized and revised existing objectives to better align with the competencies. The nomenclature system was retained from the original PCME publication and was expanded to allow easy cross reference when learning objectives were moved and combined. The nomenclature system should allow for the continued referencing of educational cases to the pathology competencies. Knowledge of pathophysiology and laboratory diagnosis continues to be essential for the practice of medicine. The PCME serve as a national peer-reviewed resource of learning objectives that should be beneficial for both students and medical educators. However, the document is designed to be a living document that is periodically revised and updated to ensure relevance as medical practice evolves. We continue to encourage comments about the pathology competencies to be sent to the authors. We also encourage continued submission of educational cases to Academic Pathology to grow this international resource.

Disease Mechanisms and Processes
A foundational knowledge of adaptive changes and mechanisms of disease including the etiology, local or systemic responses, effects, pathogenesis, consequences, molecular and cellular events is essential for understanding disease processes in organ system pathology and in patients.
There are 12 topics within this competency area. Each topic includes general learning goals and specific objectives that students should be able to meet before step 1 of the USMLE. Table 1 lists the topic areas and reference codes and shows the number of goals and objectives for each.

Topic: Genetic Mechanisms (GM)
This topic includes a basic knowledge of genetic mechanisms of disease, including inherited and somatic disorders, with the resulting consequences leading to disorders of development, metabolism, aging, stem cell biology, immunology, and the development of cancer.

Learning Goal 1: Genetic Mechanisms of Developmental and Functional Abnormalities
Apply knowledge of the genetic mechanisms of disease to discuss how changes in the genome can cause developmental and functional abnormalities at the cellular, tissue, and organism levels.
Objective GM1.1: Types of Mutations. Describe different types of mutations that can occur in human disease and discuss how each of these can produce abnormalities in DNA transcription and/or alterations in the type or amount of protein produced.
Objective GM1.2: Inheritance Patterns. Compare and contrast the inheritance patterns of different types of Mendelian disorders and give examples of each type of pattern.

Topic: Neoplasia (N)
This topic includes a basic understanding of the characteristics of benign and malignant neoplasms, epidemiologic, and environmental factors that influence neoplastic change, as well as an understanding of the molecular basis of neoplasia including oncogenes, tumor suppressor genes, carcinogenic agents, and host defense.

Learning Goal 1: Genetic Basis of Neoplasia
Apply knowledge of the genetic basis of neoplasia to explain how genetic changes are acquired, how functional alterations in these mutated genes lead to the development of cancer, and how these alterations can be exploited with therapy.

Topic: Environmental Mechanisms (EM)
This topic includes etiologies such as physical damage resulting from trauma, particles, extreme temperature, radiation, and chemical exposures to small molecules and biologic toxins that produce tissue damage. The mechanism of injury usually causes direct damage that initiates a host response that can lead to a range of consequences from resolution to a chronic complicated pathologic state.

Learning Goal 1: Injury from External Agents
Apply knowledge of biochemistry and cellular physiology to describe the mechanisms leading to cell or tissue injury induced by exposure to external agents, including radiation, environmental toxins, drugs of abuse, and therapeutic agents. Objective EM1.7: Radiation. Discuss the mechanisms by which radiation damages cells and tissues and compare and contrast how ultraviolet radiation, therapeutic radiation, and acute radiation sickness produce different disease manifestations in different organ systems.

Learning Goal 2: Physical Injury
Apply knowledge of biochemistry, anatomy, physiology, and mechanisms of cell injury to describe the pathogenic mechanisms of physical injury.
Objective EM2.1: Mechanical Force Injury. Compare and contrast the types of injuries associated with mechanical force (blunt versus penetrating) with respect to effects on skin, blood vessels, and the affected organs and discuss systemic response to massive trauma.
Objective EM2.2: Thermal Injury. Discuss thermal injuries, comparing and contrasting the direct and systemic effects of thermal burns, hyperthermia, and hypothermia and mechanisms of injury at the cellular level.

Topic: Metabolic and Nutritional Mechanisms (MN)
This topic includes the etiologic mechanisms, host responses, and disease processes leading to impairment of absorption, transport, and utilization of nutrients and oxygen, storage disorders, and disposal of waste products.

Learning Goal 1: Nutrient Deprivation or Toxicity
Apply knowledge of biochemistry and cellular physiology to explain the pathogenic mechanisms resulting from nutrient deprivation or toxicity and the resulting pathology at the cellular, tissue, and organism levels.
Objective MN1.1: Fat-and Water-Soluble Vitamins. Compare and contrast dietary sources of fat-soluble and water-soluble vitamins with respect to absorption, metabolism, and potential toxicity.
Objective MN1.2: Vitamin Deficiency Disorders. List vitamins and minerals whose deficiency can be associated with a disease process and explain the mechanisms by which these deficiencies produce disease.

Topic: Inflammatory Mechanisms (FLAM)
This topic includes the understanding of acute and chronic inflammation, including patterns of inflammation, cellular components, mediators, and systemic effects.

Learning Goal 1: Mechanisms of Inflammation
Apply knowledge of the biochemistry and cellular physiology to describe pathogenic mechanisms of acute and chronic inflammation and the resulting pathology at the cellular, tissue, and organism levels. Objective FLAM1.7: Acute, Chronic, and Granulomatous Inflammation.
Compare and contrast acute, chronic, and granulomatous inflammation with respect to the major cell type(s) involved in the processes, the types of etiologic agents that produce each of these, and the mechanisms of tissue injury seen with these different types of inflammation.
Objective FLAM1.8: Extravascular Fluids Associated with Injury. Classify, with appropriate terminology, the types of extravascular fluids associated with injury based on their cellular and protein content and provide examples of pathologic conditions in which these can be found.

Topic: Immunological Mechanisms (IM)
This topic includes the understanding of normal and dysregulated innate and adaptive cellular immune responses resulting in inflammation, resolution, and disease.

Learning Goal 1: Immune Dysfunction
Apply knowledge of basic mechanisms of immunology to explain how dysfunction can produce cellular injury, acute and chronic inflammation, autoimmunity, allergic reactions, and susceptibility to infection; how these changes affect organ function and the health of the organism; and how therapeutic intervention can mitigate these effects. Objective IM1.5: Complement. Discuss how the complement cascade is activated, the role its activation plays in both inflammation and cellular cytotoxicity, and how abnormalities in complement function can produce disease.
Objective IM1.6: Immune Tolerance. Define immunological tolerance and describe the role that failure of tolerance plays in the development of autoimmune diseases.
Objective IM1.7: Human Leukocyte Antigen (HLA). Discuss the structure and function of human histocompatibility antigens and describe the role of this system in both transplantation and susceptibility to certain diseases.
Objective IM1.8: Tissue Transplantation. Discuss the complications of tissue transplantation, including the risk of infection and neoplasia, and the pathophysiology and clinicopathologic findings of hyperacute, acute, and chronic rejection.
Objective IM1.9: Primary Immunodeficiencies. Compare and contrast the genetic basis and inheritance patterns of the well-defined primary immunodeficiency syndromes, discuss the pathogenesis and clinical manifestations of these disorders, and describe therapeutic interventions that can mitigate or correct them.
Objective IM1.10: Secondary Immune Deficiencies. Describe the etiology, mechanisms of action, and possible clinical consequences of secondary immune deficiencies.
Objective IM1.11: Bone Marrow Transplantation. Discuss common complications of bone marrow allograft transplantation, including the pathophysiologic and clinicopathologic features of acute and chronic graftversus-host disease.

Topic: Infectious Mechanisms (FECT)
This topic includes the mechanisms by which microorganisms, viruses, and parasites cause disease, including virulence factors produced by microorganisms and host response.

Learning Goal 1: Mechanisms of Infection
Apply knowledge of biochemical and cellular physiology to describe the pathogenic mechanisms and clinical manifestations of infectious diseases, including both pathogen and host factors and the resulting pathology at the cellular, tissue, and organism levels. This topic includes an understanding of the pathogenesis of cellular proliferation for regeneration of cells, including of stem cells, and tissue as well as knowledge of signal mechanisms for the repair process.
Learning Goal 1: Mechanisms of Tissue Regeneration, Renewal, and Repair Apply knowledge of biochemistry and cellular physiology to describe the pathogenic mechanisms of tissue regeneration, renewal, and repair; the resulting pathology at the cellular, tissue, and organism levels; and clinical manifestations.

Topic: Hemodynamic Disorders and Thromboembolic Disease (HDTD)
This topic includes a basic knowledge of edema, congestion, and shock as well as a basic understanding of the coagulation cascade to understand the pathogenesis of thromboembolic disorders.

Learning Goal 1: Hemodynamics and Shock
Apply knowledge of biochemical and cellular physiology to discuss the pathogenic mechanisms resulting in alterations in hemodynamics and shock. Describe the resulting pathology at the cellular, tissue, and organism level and describe clinical manifestations associated with these pathologic changes.

Learning Goal 2: Clotting and Disruption of Blood Flow
Apply knowledge of the biochemical and cellular physiology to discuss pathogenetic mechanisms that result in alterations in blood clotting or other disruptions to blood flow. Describe the resulting pathology at the cellular, tissue, and organism level and the clinical manifestations associated with these pathologic changes.
Objective HDTD2.1: Blood Clotting. Discuss the vascular, cellular, and humoral events involved in blood clotting, including factors that involve primary and secondary hemostasis and antithrombotic regulation, and provide examples of genetic or acquired factors that can lead to either excess clotting or bleeding.
Objective HDTD2.2: Thrombosis and Thromboembolism. Compare and contrast mechanism of thrombosis in situ and thromboembolism with respect to sites of involvement, risk factors, and attendant pathologic and clinical consequences.
Objective HDTD2.3: Embolism. Describe the mechanism of embolus formation from different sources and compare and contrast the clinical settings and consequences of each.
Objective HDTD2.4 (Formerly C2HPCD2.5): Mechanisms of Hypercoagulability. Compare and contrast the roles of endothelial injury, stasis, and alterations in the regulation of blood clotting in the development of the hypercoagulable state.

Topic: Adaptation and Cell Death (ACD)
This topic includes a basic understanding of the cellular responses to stress, mechanisms of cellular injury, and differentiation of necrosis and apoptosis.

Learning Goal 1: Cellular Response to Injury
Apply knowledge of membrane physiology, metabolism, signal transduction, and macromolecular synthesis to discuss cellular responses to injury at the cell, tissue, and organism levels; how these responses affect morphologic appearance; and how they can be used for diagnostic, prognostic, and therapeutic purposes.
Objective ACD1.1: Adaptation. Discuss the pathogenesis of hyperplasia, hypertrophy, atrophy, and metaplasia and compare and contrast their possible physiologic and pathologic causes.
Objective ACD1.2: Necrosis. Define necrosis and compare and contrast the forms of necrosis produced in response to different etiologic agents with respect to their variable clinical and morphologic features.
Objective ACD1.3: Ischemia. Compare and contrast ischemia and hypoxia and discuss the time course of the molecular events that occur in a cell in response to lack of oxygen, emphasizing the events that distinguish reversible from irreversible injury.
Objective ACD1.4: Reperfusion Injury. Summarize the cell's response to reperfusion injury, emphasizing how reperfusion can exacerbate injury produced by ischemia.

Learning Goal 2: Cell Death
Apply knowledge of biochemistry and cellular physiology to differentiate between pathogenic and physiologic mechanisms of cell death, the resulting morphologic appearance, and the physiologic and clinical settings in which these mechanisms are activated.
Objective ACD2.1: Apoptosis. Contrast the etiology, mechanisms, and morphologic changes of apoptosis with those of necrosis. Discuss the circumstances in which dysregulation of apoptosis can produce disease and circumstances that determine why cells undergo apoptosis vs. necrosis.

Learning Goal 3: Sublethal Injury
Apply knowledge of cellular physiology, metabolism, and macromolecular synthesis to discuss cellular and subcellular responses to sublethal injury or stress on cells; how these responses affect morphologic appearance at the cell and tissue level; and how they can affect organ function.
Objective ACD3.1: Cellular Response to Stress or Injury. Discuss, with examples, the pathologic changes that occur in cellular organelles or cytoskeletal proteins of different cell types in response to stress or injury.
Objective ACD3.2: Intracellular Accumulations. Describe the mechanisms of intracellular accumulations and the morphologic and clinical consequences of these accumulations.

Topic: Developmental Processes (DEV)
This topic includes a basic knowledge of common morphologic abnormalities to understand the pathogenesis of developmental disorders.

Learning Goal 1: Development
Apply knowledge of embryology to describe the anatomy and physiology of developmental defects and problems related to prematurity.

Topic: Geriatrics (GER)
This topic includes a basic knowledge of cellular physiology to understand the pathogenesis of aging.

Learning Goal 1: Mechanisms of Aging
Apply knowledge of cellular physiology and biochemistry to describe the pathogenic mechanisms of aging.
Objective GER1.1: Aging. Describe the pathogenesis of aging at the cellular level, discussing decreased cellular function, cellular damage and accumulations, and decreased DNA repair.

Organ System Pathology
Once the student has mastered the fundamental mechanisms and processes for causing, sustaining, extending, or resolving injury, this knowledge can be integrated to understand how pathology in each organ system affects the initial pathologic site, multi-organ systems, and the overall function of the patient. There are 23 topics within this competency area. Each topic includes general learning goals and specific objectives that medical students should be able to meet upon graduation from medical school. Table 2 lists the topic areas and shows the number of goals and objectives for each.
Topic: Cardiovascular-Blood Vessels (CBV) Cardiovascular disorders resulting from abnormal development, hypoxia, immune dysregulation, infections, neoplasms, and smooth muscle changes as they relate to the blood vessels are enumerated.

Learning Goal 1: Mechanisms of Atherosclerosis
Apply knowledge of immunologic principles, inflammation, and tissue repair to explain atherosclerosis and its complications. Objective CBV1.5: Pathogenesis of Atherosclerosis. Describe the pathogenesis of atherosclerotic plaque formation and the different lesions that may be seen at various stages as well as most common vessels in which it develops.

Learning Goal 2: Vascular Aneurysms and Dissection
Apply knowledge of the structure and components of blood vessels, vascular physiology, and basic hemodynamic principles to explain the development, manifestations, and consequences of vascular aneurysms and dissection.

Learning Goal 3: Vasculitis
Apply knowledge of microbiological principles and mechanisms of immunologically mediated disease to discuss the pathogenesis, clinical presentation, morphological features, and laboratory diagnosis of the different vasculitides.
Objective CBV3.1: Drug-induced Vasculitis. Describe the pathogenesis of a drug-induced vasculitis. Topic: Cardiovascular-Heart (CH) Cardiovascular disorders resulting from abnormal development, hypoxia, immune dysregulation, infections, neoplasms, and intrinsic muscle disease as they relate to the heart are enumerated.

Learning Goal 1: Heart Failure
Apply knowledge of anatomy, physiology, and general pathophysiologic principles to describe the pathogenesis and clinical and morphologic features of heart failure.
Objective CH1.1: Right-and Left-Sided Heart Failure. Compare and contrast right heart failure versus left heart failure in terms of pathogenesis, clinical features, pathologic features, and the short-term and long-term consequences.

Learning Goal 2: Atherosclerosis in Heart Disease
Apply knowledge of anatomy, physiology, and general pathophysiologic principles to explain how atherosclerosis leads to heart disease and death.
Objective CH2.1: Ischemic Heart Disease. Explain how ischemic heart disease can progress while remaining entirely free of symptoms for many years.
Objective CH2.2: Angina. Contrast the clinical, physiologic, and morphologic differences between stable angina and unstable angina.
Objective CH2.3: Reperfusion Versus Ischemic Injury. Contrast the behavior of the myocardium that has been subjected to chronic ischemia alone from that of reperfused myocardium following therapy for infarction.
Objective CH2.4: Timing of Changes in Myocardial Infarction. Compare and contrast the gross and microscopic features and pathophysiologic changes of acute myocardial infarction through remote myocardial infarction, describing the spectrum of changes that occur at specific times.

Learning Goal 3: Cardiovascular Malformation
Apply knowledge of embryologic principles to describe how improper development of the heart and blood vessels leads to cardiac dysfunction.
Objective CH3.1: Congenital Heart Disease. Name the most common forms of congenital heart disease and outline their clinical presentation, natural history, and long-and short-term complications.
Objective CH3.2: Congenital Heart Disease Associated with Genetic Disorders. Name several common genetic disorders associated with congenital heart disease, describing the clinical presentations and pathogenesis.
Objective CH3.3: Paradoxical Embolism. Describe a paradoxical embolus and its relationship to congenital heart disease.
Objective CH3.4: Cardiac Shunts. Define the concepts of left-to-right shunt, right-to-left shunt, and shunt reversal and correlate with clinical presentation.

Learning Goal 4: Cardiac Inflammatory Conditions
Apply knowledge of immunological and microbiological principles to explain the role of infectious agents and inflammatory conditions in myocardial dysfunction and describe the related clinical presentations.
Objective CH4.1: Rheumatic Fever. Describe the major cardiac and extracardiac manifestations of rheumatic fever, including its effect on the endocardium, myocardium, and pericardium.
Objective CH4.2: Rheumatic Fever and Endocarditis. Compare and contrast the effects of rheumatic fever and bacterial endocarditis on the heart. Objective CH4.3: Infective Endocarditis. Describe the two major patterns of infective endocarditis and the pathologic changes seen in the cardiac valves.
Objective CH4.4: Noninfective Endocarditis. Discuss the pathologic features of noninfective endocarditis on the cardiac valves.
Objective CH4.5: Myocarditis. Describe the clinicopathologic features and common causes of myocarditis and their consequences.
Objective CH4.6: Pericarditis. Summarize the common causes of pericarditis and the resultant clinicopathologic features.

Learning Goal 5: Valvular Dysfunction
Apply knowledge of the anatomy and physiology of heart valves to explain how valvular dysfunction leads to heart failure and describe the related clinical presentation.

Learning Goal 6: Hypertension
Apply knowledge of the mechanism of hypertension and how tissues respond to increased resistance to describe the clinical and pathologic changes seen in systemic and pulmonary hypertension.

Learning Goal 7: Cardiomyopathy
Apply knowledge of the mechanism of myocardial function to describe the clinicopathologic features of cardiac and systemic disorders that lead to cardiac myocyte dysfunction.

Learning Goal 8: Cardiac Neoplasms
Apply knowledge of the molecular basis of neoplasia to describe the pathogenesis, clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, and prognosis of neoplasms affecting the heart.
Objective CH8.1: Cardiac Neoplasms. Compare and contrast the pathogenesis and clinicopathologic features of primary and secondary cardiac tumors.

Topic: Hematopathology-Red Cell Disorders (HRC)
Red blood cell (RBC) disorders resulting from abnormal development, nutritional derangements, inherited disorders, blood loss, and intrinsic disease as they relate to anemia and polycythemia.

Learning Goal 1: Anemia
Apply knowledge of nutritional biochemistry, erythropoiesis, and RBC structure and function to a discussion of the behavioral, hereditary, developmental, and chronic causes of anemia. Objective HRC1.5: Anemias of Red Cell Destruction. Explain the mechanisms by which anemia is produced on the basis of shortened red cell survival, distinguishing between intrinsic and extrinsic causes of red cell destruction.
Objective HRC1.6: Aplastic Anemia. Retired. Use C2 HWC5.6 Objective HRC1.7: Hemoglobinopathies and Thalassemia. Describe the structural alterations and regulatory abnormalities associated with hemoglobinopathies and thalassemia and discuss how these abnormalities give rise to the clinical manifestations of these diseases.
Objective HRC1.8: Blood Loss. Discuss the pathogenesis and clinicopathologic features of anemia associated with acute and chronic blood loss.

Learning Goal 2: Polycythemia
Apply knowledge of physiology, erythropoiesis, environmental factors, and RBC structure and function to a discussion of the causes of polycythemia.
Objective HRC2.1: Polycythemia. Describe the pathogenesis and clinicopathologic features of disorders resulting in increased red cell mass (primary and secondary polycythemia) and contrast to relative polycythemia.
Topic: Hematopathology-White Cell Disorders, Lymph Nodes, Spleen, and Thymus (HWC) Disorders of white blood cells and hematolymphoid tissues resulting from abnormal development, genetic mutations, neoplasms, infections, and intrinsic disease as they relate to reactive and neoplastic abnormalities are enumerated.

Learning Goal 1: Development of White Blood Cells and Nonneoplastic Causes of Neutropenia
Apply knowledge of anatomy, histology, and physiology to describe the normal development of white blood cells and non-neoplastic conditions leading to increased or decreased numbers of white blood cells.

Learning Goal 2: Genetic Mutations in Hematologic Malignancy
Apply knowledge of general concepts of neoplasia to explain how genetic mutations can produce hematologic malignancies and how the clinical behavior of different malignancies can be explained by different mutations. Objective HWC2.6: Clonal Hematopoiesis. Define clonal hematopoiesis, discuss its relationship to bone marrow disorders, and describe some of its systemic consequences.

Learning Goal 3: Classification of Leukemia and Lymphomas
Apply knowledge of hematopoiesis to discuss the pathophysiologic basis for the classification of leukemia and lymphomas.
Objective HWC3.1: Morphology of Acute Leukemia and Lymphoma. Describe the morphologic features that characterize typical cases of acute leukemia and lymphoma.
Objective HWC3.2: Myeloid Neoplasia. Compare and contrast myelodysplastic syndromes, myeloproliferative neoplasms, and acute myeloid leukemia with respect to morphologic appearance, clinical features, and underlying pathophysiology.
Objective HWC3.3: Categories of Lymphoma. Compare and contrast lowgrade or indolent lymphomas and high-grade or aggressive lymphomas with respect to morphologic appearance, clinical features, and underlying pathophysiology.
Objective HWC3.4: Morphology of Acute and Chronic Leukemia. Compare and contrast the morphologic appearance of myeloblasts, lymphoblasts, and mature lymphocytes and distinguish acute myeloid leukemia from chronic myeloid leukemia.
Objective HWC3.5: Morphology of Lymphomas. Describe the histologic appearance of typical cases of follicular lymphoma, diffuse large B-cell lymphoma, small lymphocytic lymphoma/chronic lymphocytic leukemia, and Hodgkin lymphoma.
Objective HWC3.6: Hodgkin and Non-Hodgkin Lymphoma. Compare and contrast Hodgkin lymphoma with at least 2 non-Hodgkin lymphomas with respect to age and clinical symptoms at presentation, sites and pattern of spread of disease, cell of origin, histologic appearance, and prognosis and response to therapy.

Learning Goal 4: Clinical Features of Hematolymphoid Neoplasms
Discuss the clinical manifestations of hematolymphoid neoplasms, including age distribution of different tumors, presenting symptoms and signs, disease complications, natural history, and response to therapy.
Objective HWC4.1: Clinical Features of Bone Marrow Neoplasms. Identify the tumors of bone marrow most likely to present with anemia, leukopenia, or thrombocytopenia and discuss the presenting clinical features most likely to be associated with each.
Objective HWC4.2: B Symptoms in Hematolymphoid Neoplasia. Define B symptoms, list which lymphomas are most and least likely to be associated with them, and discuss the prognostic implications of B symptoms in these diseases.

Learning Goal 7: Spleen
Apply knowledge of the anatomy and function of the spleen to explain how developmental anomalies, immune and metabolic disorders, and neoplasia lead to splenic dysfunction.
Objective HWC7.1: Splenic Function. Explain the contribution of normal splenic function to non-neoplastic diseases.
Objective HWC7.2: Splenomegaly. Describe the clinical features, causes, and pathologic findings of neoplastic and non-neoplastic disorders leading to splenomegaly.

Topic: Hematopathology-Platelets and Coagulation Disorders (HPCD)
Platelet disorders resulting from abnormal development, inherited disorders, acquired disorders, immune mechanisms, and infectious diseases and their central role in blood clotting as they relate to coagulation and hemostasis abnormalities are enumerated.

Learning Goal 1: Platelets
Apply knowledge of platelet structure and function to discuss qualitative and quantitative disorders leading to abnormal bleeding.
Objective HPCD1.1: Platelets in Hemostasis. Summarize the role played by platelets in hemostasis, including platelet adhesion, activation, and aggregation.
Objective HPCD1.2: Thrombocytopenia. Identify the examples of each of the following pathogenetic categories of thrombocytopenia: decreased production, decreased platelet survival, sequestration, and dilutional effect.
Objective HPCD1.5: Platelet Disorders. Explain the biochemical basis of the following congenital and acquired defective platelet disorders: Bernard-Soulier syndrome, Glanzmann thrombasthenia, storage pool disorders, aspirin-related dysfunction, and uremia-related dysfunction.
Objective HPCD1.6: Bone Marrow Aplasia. Explain the bases of marrow aplasia/myelophthisis, nutritional deficiency, and myelodysplasia as causes of thrombocytopenia from marrow failure.

Learning Goal 2: Hemostasis
Apply knowledge of normal hemostasis, interaction of platelets, and procoagulant and anticoagulant factors to describe qualitative and quantitative disorders leading to abnormal bleeding and thrombosis.

Topic: Respiratory System (RS)
Respiratory disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to lung abnormalities are enumerated.

Learning Goal 1: Vascular Diseases of the Lung
Apply knowledge of the structure and function of blood vessels and pulmonary vascular physiology to explain the pathogenesis, clinical manifestations, and pathologic findings in disorders affecting the pulmonary vasculature. Explain how each of the following cardiopulmonary conditions contributes to pulmonary hypertension: increased pulmonary blood flow or pressure, increased pulmonary vascular resistance, and left heart resistance to blood flow.
Objective RS1.5: Pathogenesis of Pulmonary Hypertension. Describe the pathogenesis of pulmonary hypertension in hereditary and secondary forms and the characteristic gross and microscopic morphologic features of each.
Objective RS1.6: Goodpasture Syndrome and Granulomatosis with Polyangiitis. Compare and contrast the clinical manifestations, pathogenesis, and pathologic findings of Goodpasture syndrome and granulomatosis with polyangiitis (formerly known as Wegener granulomatosis).
Objective RS1.7: Pulmonary Edema. Outline the pathogenesis and clinicopathologic features of disorders presenting with pulmonary edema and common conditions in which it occurs.
Objective RS1.8: Acute Lung Injury. Discuss the pathogenesis and clinicopathologic features of acute lung injury and common settings in which it develops.

Learning Goal 2: Pulmonary Infection
Apply knowledge of the local pulmonary defense mechanisms and systemic host resistance to infection to discuss pathogenesis, classification, clinical manifestations, and pathologic findings in lower respiratory tract infections in immunocompetent and immunocompromised hosts.
Discuss the common infectious agents that produce pulmonary disease that are generally associated with defects in innate, humoral, or cellmediated immunity.

Learning Goal 3: Lung Neoplasia
Apply knowledge of neoplasia to describe the clinical presentation, pathophysiology, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of lung neoplasms.

Learning Goal 6: Respiratory Disorders of the Fetus and Infant
Apply knowledge of the embryology of the respiratory tract and pulmonary development to outline the pathogenesis, morphological features, and clinical presentation of developmental anomalies and acquired newborn disorders.
Objective RS6.1: Respiratory Disorders of the Fetus and Infant. Explain the pathogenesis and clinicopathologic features of congenital and acquired disorders affecting the airways and lungs of the fetus and infant.

Learning Goal 7: Pleural Disorders
Apply knowledge of the structure and function of pleura to explain the pathogenesis, clinical manifestations, and pathologic findings of pleural disorders.
Objective RS7.2: Pleural Neoplasms. Describe the clinicopathologic findings of neoplasms involving the pleura and pleural cavity.

Topic: Head and Neck (HN)
Head and neck disorders resulting from abnormal development, genetic mutations, immune dysfunction, neoplasms, and intrinsic disease as they relate to the oral cavity, teeth, pharynx, nose, nasal cavity, sinuses, larynx, lower airways, ear, neck, and salivary glands are enumerated.

Learning Goal 1: Non-neoplastic Salivary Gland Disorders
Apply knowledge of the structure and function of the salivary glands to an understanding of the pathogenesis and clinicopathologic features associated with disorders presenting with gland enlargement and/or dysfunction.
Objective HN1.1: Salivary Duct Obstruction. Describe the potential causes for obstruction of the salivary gland duct and explain how a mucocele is formed.
Objective HN1.2: Sialadenitis. Discuss inflammation of the salivary glands arising from trauma, infection, or autoimmune dysregulation and discuss their potential neoplastic complications.
Objective HN1.3: Sjogren Syndrome. Describe Sjogren syndrome and discuss how it relates to salivary gland dysfunction, its effect on multiple organ systems, complications, and long-term risks.

Learning Goal 2: Head and Neck Neoplasia
Apply knowledge of the etiology, pathogenesis, morphological appearance, and classification of neoplasms involving the salivary glands, oral cavity, upper airways, neck, nose, sinuses, ear, and larynx to their diagnosis, prediction of biological behavior, prevention, and treatment.

Topic: Gastrointestinal Tract (GT)
Gastrointestinal (GI) tract disorders resulting from abnormal development, genetic mutations, immune disorders, infections, neoplasms, and intrinsic disease as they relate to abnormalities of the esophagus, stomach, and intestine are enumerated.

Learning Goal 1: Developmental Disorders of the Gut
Apply knowledge of the embryology of the foregut, midgut, and hindgut to summarize the morphological features and clinical presentation of developmental anomalies.

Learning Goal 2: Vascular Disorders of the Gut
Apply knowledge of the gross anatomy of the GI tract and hemodynamic principles to discuss vascular disorders of the gut.
Objective GT2.1: Ischemic Disorders of the Gut. Explain the pathogenesis and clinicopathological features for common disorders of the GI tract that arise from hypoxia or ischemia.
Objective GT 2.3: Gastrointestinal Bleeding. Explain the pathogenesis and clinicopathological features and outline the underlying disorders associated with hematemesis, hematochezia, and melena.

Learning Goal 3: GI Neoplasia
Apply knowledge of neoplasia to explain the clinical presentation, inheritance risk, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of gastrointestinal neoplasms.

Learning Goal 7: GI Infections
Apply knowledge of common pathogens and principles of immunity to describe the morphological features and clinical presentation of infectious diseases affecting the GI tract of immunocompetent and immunocompromised patients.
Objective GT7.1: GI Infections. Compare the underlying mechanism and clinicopathologic features of GI tract involvement by common bacterial, fungal, viral, and parasitic pathogens.

Learning Goal 2: Liver Toxins
Apply knowledge of the cellular response to injury, the pathogenic mechanisms leading to disease, and the biochemical alterations of hepatic function to explain the clinicopathologic features, prognosis, and treatment of disorders resulting from ethanol and other drugs and toxins.
Objective HB2.1: Steatosis. Describe the clinicopathologic features of excessive ethanol ingestion, focusing on biochemical pathways and short-and long-term complications, and compare and contrast alcoholic with nonalcoholic fatty liver disease.
Objective HB2.2: Acetaminophen Toxicity. Describe the clinicopathologic features of excessive acetaminophen ingestion focusing on biochemical pathways and short-and long-term complications.
Objective HB2.4: Toxic and Therapeutic Injury. Compare and contrast the effects of common toxic and therapeutic agents to the liver, including the patterns of injury, clinical consequences, and sequelae.

Learning Goal 3: Hepatic Neoplasms
Apply knowledge of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of hepatic neoplasms.

Learning Goal 4: Inflammatory Hepatobiliary (HB) Disorders
Apply knowledge of the cellular response to injury, the pathogenic mechanisms leading to disease, and the biochemical alterations of hepatic function to describe the clinicopathologic features and prognosis of intrahepatic and extrahepatic biliary tract diseases.

Learning Goal 8. Circulatory Disorders Affecting Liver
Apply knowledge of the vascular anatomy and physiology and principles of coagulation to an understanding of how vascular disorders that affect the liver develop, their clinical presentation, and potential complications.
Objective HB8.1: Circulatory Disorders of Liver. Discuss the etiology, clinical presentation, and consequences of altered local and systemic circulatory problems affecting the liver (e.g., chronic passive congestion, hepatic venous outflow and portal vein obstruction, and impaired blood flow to the liver).

Learning Goal 9. Liver Failure
Apply knowledge of anatomy and hepatobiliary physiology to an understanding of the clinicopathologic features and complications resulting from acute and chronic disorders of liver function. Objective HB9.4 (Formerly HB1.6): Cirrhosis. Classify the types of cirrhosis in terms of etiology, pathogenesis, and morphologic pattern (gross and microscopic).

Topic: Pancreas (P)
Pancreatic disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to exocrine pancreatic abnormalities are enumerated.

Learning Goal 1: Non-neoplastic Disorders of the Exocrine Pancreas
Apply knowledge of the structure and function of the pancreas to an understanding of the clinicopathologic features and diagnostic criteria of disorders resulting from cellular injury to the exocrine pancreas.

Learning Goal 2: Pancreatic Neoplasia
Apply knowledge of the molecular basis of neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of pancreatic neoplasms.
Objective P2.1: Neoplasia of the Pancreas. Describe the major types of neoplasms affecting the exocrine pancreas.

Objective P2.2: Clinical Features of Pancreatic Adenocarcinoma.
Explain how the location of a pancreatic neoplasm determines its presenting symptoms and discuss the risk factors for pancreatic adenocarcinoma.

Topic: Kidney (UTK)
Kidney disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to renal abnormalities are enumerated.

Learning Goal 1: Renal Neoplasia
Apply knowledge of neoplasia to explain the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, and prognosis of renal neoplasms.

Learning Goal 3: Renal Vascular Dysfunction
Compare and contrast the common causes of renal vascular dysfunction in terms of size and types of vessels involved, characteristic gross and microscopic morphology, pathogenesis, and clinical presentation.

Learning Goal 5: Glomerular Disorders
Apply knowledge of the structure and function of the kidney to describe the pathogenetic mechanisms, diagnostic criteria, and clinicopathologic features of glomerular diseases presenting with asymptomatic proteinuria, nephrotic syndrome, and nephritic syndrome.

Topic: Bladder (UTB)
Bladder disorders resulting from abnormal development, genetic mutations, infections, neoplasms, obstruction, and intrinsic disease as they relate to bladder/urinary tract abnormalities are enumerated.

Learning Goal 1: Bladder Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, and prognosis of bladder neoplasms.

Learning Goal 2: Bladder Infection
Apply knowledge of innate and adaptive immunity and pathogenic organisms infecting the bladder and their transmission to explain the natural history, pathogenesis, diagnosis, histopathological features, and prevention of cystitis.

Learning Goal 3: Urinary Obstruction
Apply knowledge of the anatomy and physiology of the kidney to describe how disorders may lead to obstruction of urinary outflow.

Topic: Male Reproductive-Penis (MRP)
Penile disorders resulting from congenital anomalies, infections, and neoplastic disease as they relate to the penis are enumerated.

Learning Goal 1: Non-neoplastic Disorders of the Penis
Apply knowledge of urinary tract embryology, inflammatory mechanisms, and infectious agents to summarize the epidemiology, clinicopathological features, and treatment strategies for non-neoplastic disorders of the penis.

Learning Goal 2: Neoplastic Disorders of the Penis
Apply knowledge of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and therapy of penile neoplasms.
Objective MRP2.1: Penile Squamous Neoplasia. Explain the spectrum of squamous neoplasia affecting the penis, ranging from condyloma acuminata to invasive squamous cell carcinoma, describing the risk factors, pathogenesis, morphologic features, complications, and treatment strategies.

Topic: Male Reproductive-Prostate (MP)
Prostate disorders resulting from genetic mutations, infections, neoplasms, and intrinsic disease as they relate to prostate abnormalities are enumerated.

Learning Goal 1: Prostate Neoplasia
Apply knowledge of the molecular and cellular origins of prostate cancers, specifically adenocarcinoma, to summarize the epidemiology, clinicopathological features, natural history, and treatment strategies for this disease. Objective MP1.4: "Histological" versus "Clinically Significant" Prostatic Adenocarcinoma. Compare and contrast the significance of "histological" prostatic adenocarcinoma versus a "clinically significant" adenocarcinoma.

Learning Goal 2: Non-neoplastic Disorders of the Prostate
Apply knowledge of the molecular and cellular origins of non-neoplastic disorders of the prostate, specifically prostatitis and nodular hyperplasia, to explain the epidemiology, clinicopathological features, natural history, and treatment strategy for these diseases.
Objective MP2.1: Nodular Hyperplasia. Explain the molecular and hormonal origins of prostatic nodular hyperplasia, the area of the gland affected, the natural history of the disease, various treatment strategies, and anticipated outcomes of treatment.
Objective MP2.2: Prostatitis. Describe the pathophysiologic basis for inflammatory conditions affecting the prostate, including the causative organisms.

Topic: Male Reproductive-Testes (MT)
Testicular disorders resulting from abnormal development, neoplasms, infections, and intrinsic disease as they relate to testicular abnormalities are enumerated.

Learning Goal 1: Non-neoplastic Disorders of the Testes and Epididymis
Apply knowledge of the molecular and cellular origins of non-neoplastic disorders of the testis to explain the epidemiology, clinicopathological features, natural history, and treatment strategy for these diseases.

Learning Goal 2: Testicular Neoplasia
Apply knowledge of the molecular and cellular origins of the common types of testicular cancer to explain the epidemiology, clinicopathological features, natural history, and treatment strategies for this disease.
Objective MT2.1: Tumors of the Testis. Describe the most important risk factors, genetic associations, and molecular basis for the development of testicular tumors and outline the clinicopathologic features for the different morphologic patterns seen.

Topic: Breast (BR)
Breast disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to breast abnormalities are enumerated.

Learning Goal 1: Non-neoplastic Disorders of the Breast
Apply knowledge of embryology, cellular responses to injury, neoplasia, and biologic and molecular alterations to describe the clinical presentation, inheritance risk, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and therapy of non-neoplastic disorders of the breast.

Learning Goal 2: Breast Neoplasms
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of breast neoplasms.

Learning Goal 1: Uterine Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of uterine neoplasms.

Learning Goal 2: Non-neoplastic Uterine Disorders
Apply knowledge of uterine physiology, endocrinology, and anatomy to compare and contrast the clinical presentation and pathology of common non-neoplastic uterine disorders.
Objective FU2.2: Menstrual Cycle. Identify the phases of the menstrual cycle and the major hormonal changes that occur, comparing normal menstruation to common causes of abnormal bleeding in adolescents, perimenopausal, and postmenopausal women.
Objective FU2.3: Uterine Adenomyosis. Compare and contrast the pathology of adenomyosis with endometriosis.

Learning Goal 3: Cervical Neoplasia
Apply knowledge of molecular and virus-induced principles of neoplasia to describe the detection, clinical presentation, pathogenesis, morphologic appearance, and prevention of cervical neoplasms.

Topic: Female Reproductive-Ovary (FO)
Ovarian disorders resulting from abnormal development, genetic mutations, infections, immune mechanisms, neoplasms, and intrinsic disease as they relate to the ovary are enumerated.

Learning Goal 1: Ovarian Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of ovarian neoplasms

Topic: Female Reproductive-Disorders of Pregnancy (FDP)
Pregnancy disorders resulting from abnormal implantation, genetic mutations, hemodynamic disturbances, immune mechanisms, infections, and intrinsic disease as they relate to gestational disease abnormalities are enumerated.

Learning Goal 1: Disorders of Pregnancy
Apply knowledge of embryology, cellular responses to injury, hemodynamics, and molecular alterations to summarize the clinical presentation, morphologic appearance, classification, diagnosis, biologic behavior, and therapy for disorders of pregnancy.
Objective FDP1.1: Ectopic Pregnancy. Describe risk factors, characteristic morphologic findings, potential outcomes, and the medical/surgical options for the management of ectopic pregnancy in relation to the pathogenesis and likelihood of adverse consequences.
Objective FDP1.2: Spontaneous Abortion. List several fetal and maternal causes for spontaneous abortion and indicate which is the most common.
Objective FDP1.3: Late Pregnancy. Describe how disorders of late pregnancy can lead to effects that threaten the mother and/or fetus.
Objective FDP1.4: Infections During Pregnancy. Discuss the ascending and hematogenous infections occurring during pregnancy in terms of etiology, pathogenesis, morphology, methods of diagnosis, prognosis, and treatment.
Objective FDP1.5: Eclampsia. Explain the principal pathophysiologic aberrations of the placenta and maternal circulation in preeclampsia and eclampsia; the characteristic morphologic features in the placenta, liver, kidney, and brain; and how management is affected by gestational age and severity of disease.
Objective FDP1.6: Gestational Trophoblastic Disease. Explain, with specific examples, how to differentiate forms of gestational trophoblastic disease based on etiology, pathogenesis, morphologic features, clinical features, and laboratory findings, including potential consequences and/or subsequent risks, treatment, and prognosis for each.
Objective FDP1.7: Gestational Diabetes. Describe the pathophysiologic effects of diabetes mellitus on the mother and fetus.

Topic: Endocrine (EN)
Endocrine disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to multiple endocrine organ abnormalities are enumerated.

Learning Goal 1: Hyper-and Hypopituitarism
Apply knowledge of pituitary physiology to describe the pathophysiology and clinicopathologic features of disorders associated with hyperpituitarism and hypopituitarism.

Learning Goal 3: Autoimmune Thyroiditis
Apply knowledge of immune system dysregulation to summarize immune-related disorders of the thyroid.

Learning Goal 4: Hyper-and Hypoadrenalism
Apply knowledge of adrenal physiology to describe the pathophysiology and clinicopathologic features of disorders associated with adrenocortical hyperfunction (hyperadrenalism) and adrenocortical insufficiency.

Learning Goal 5: Endocrine Neoplasms
Apply knowledge of the molecular basis of neoplasia to explain the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of endocrine neoplasms.
Objective EN5.1: Thyroid Neoplasms. Compare and contrast the clinicopathologic features, pathogenesis, and prognosis of follicular adenomas, follicular carcinoma, and papillary thyroid carcinoma. Objective EN5.6: Neuroblastoma. Describe the spectrum of clinical and pathologic features associated with the peripheral neuroblastic tumors neuroblastoma, ganglioneuroblastoma, and ganglioneuroma as well as important prognostic indicators.

Learning Goal 6: Endocrine Pancreas
Apply knowledge of genetics, the structure and function of the endocrine pancreas, and biochemical principles of carbohydrate metabolism to summarize the clinicopathologic features, diagnostic criteria, and therapy of disorders resulting from the excess or decreased production of insulin and other islet cell hormones and of other hereditary conditions related to the endrocrine pancreas.

Learning Goal 7: Hyperparathyroidism and Hypoparathyroidism
Apply knowledge of the structure and function of the parathyroid glands and biochemical principles of calcium, phosphate, and vitamin D metabolism to summarize the clinicopathologic features, diagnostic criteria, and therapy of disorders resulting from excess or decreased production of parathyroid hormone.
Objective EN7.1: Hyperparathyroidism. Describe the causes and clinicopathologic features of primary, secondary, and tertiary hyperparathyroidism including potential effects on bone.
Objective EN7.2: Hypoparathyroidism. Describe the causes and clinical features of hypoparathyroidism.

Topic: Skin (SK)
Skin disorders resulting from abnormal development, genetic mutations, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to cutaneous abnormalities are enumerated.

Learning Goal 1: Classification of Skin Disease
Apply knowledge of histology, cell biology, inflammation, and neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, and classification of diseases of the skin.
Objective SK1.1: Pathophysiology of Changes in the Skin. Describe the pathophysiologic basis for changes in the color, surface texture, swelling, temperature, and sensitivity of skin.
Objective SK1.2: Terminology of Clinical and Histologic Skin Changes. Describe the gross (clinical) and microscopic appearance of skin lesions using appropriate terminology.

Learning Goal 2: Barrier Breakdown of the Skin
Apply knowledge of immunology and the anatomic structure of the skin to discuss the role of skin in protecting against direct invasion of the skin and its appendages by pathogens and non-infectious agents.
Objective SK2.1: Non-infectious Effects on Skin Barrier. Describe the various chemical and physical processes that result in breakdown of the cutaneous barrier and discuss the clinical consequences.
Objective SK2.2: Cutaneous Infections. Describe common bacterial, viral, fungal, and parasitic agents that may cause cutaneous infections and the sites that they infect, their morphologic features, and their complications.
Objective SK2.3: Cutaneous Infestations. Discuss the epidemiology, clinical features, and methods of acquiring common infestations of the skin, such as scabies, lice, and bedbugs.

Learning Goal 3: Immune-related Disorders of the Skin
Apply knowledge of basic concepts in immunopathology and the key immunologic functions of components of the skin to understand the pathologic basis of disease caused by reactivity to exogenous agents versus immunologically driven disease, including those with a genetic component.

Learning Goal 4: Inherited Disorders of the Skin
Apply knowledge of genetics, skin structure and function, and basic principles of pathology to an understanding of non-neoplastic-inherited disorders of the skin.
Objective SK4.1: Inherited Diseases of the Skin. Describe the genetic basis, manifestations, and clinical outcomes for blistering diseases and other inherited disease affecting the skin.

Learning Goal 5: Skin Neoplasia
Apply knowledge of the molecular basis of neoplasia to an understanding of the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and therapy of benign and malignant skin neoplasms.

Learning Goal 6: Skin Appendage Disorders
Apply knowledge of histology of the skin appendages and environmental and immunologic factors to understand the pathophysiology of skin appendage disorders.
Objective SK6.1: Alopecia. Compare and contrast the various clinical presentations and pathogenesis of alopecia.
Objective SK6.2: Skin Appendage Disorders. Compare and contrast the clinical presentation and pathogenesis of common skin appendage disorders such as acne, panniculitis, and rosacea.

Topic: Musculoskeletal System (MS)
Musculoskeletal disorders resulting from abnormal development, genetic mutations, nutritional disorders, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to muscle, bone, and soft tissue abnormalities are enumerated.

Learning Goal 1: Bone Neoplasia
Apply knowledge of the molecular basis of neoplasia to describe the clinical presentation, biologic behavior, morphologic appearance, classification, diagnosis, prognosis, and targeted therapy of bone neoplasms. Objective MS1.4: Metastatic Tumors. Describe the tumors that commonly metastasize to bone, the radiologic manifestations of metastatic lesion involving bone, and the difference between osteoblastic and osteolytic metastases.
Objective MS1.5: Soft Tissue Tumors. Describe the common benign and malignant soft tissue tumors, including the genetic contributions to tumor development and progression.

Learning Goal 2: Non-neoplastic Disorders of the Musculoskeletal System
Apply knowledge of histology, immunology, microbiology, and biological and molecular alterations to discuss clinical presentation, biological behavior, morphological appearance, and natural history of nonneoplastic disorders of bones, joints, and skeletal muscle.
Objective MS2.1: Osteomalacia and Rickets. Compare and contrast osteomalacia and rickets with respect to pathogenesis and clinicopathologic features.
Objective MS2.2: Osteomyelitis and Septic Arthritis. Discuss the pathogenesis of osteomyelitis and septic arthritis, including predisposing factors, organisms involved, morphologic appearance, and complications.
Objective MS2.3: Osteoporosis. Distinguish primary from secondary osteoporosis in terms of etiology, pathogenesis, and morphology.
Objective MS2.4: Spinal Degenerative Disease. Describe the common degenerative diseases of the spine.
Objective MS2.5: Pathologic Fracture. Compare and contrast pathologic versus non-pathologic fractures, including the potential for healing.
Objective MS2.6: Paget Disease. Discuss the clinicopathologic changes of Paget disease, including the histologic phases and complications of this disorder.
Objective MS2.7: Arthritis. Compare and contrast rheumatoid and osteoarthritis, including the etiology, pathogenesis, clinical features, and morphology of each.
Objective MS2.9: Inflammatory Arthritis. Compare and contrast rheumatoid arthritis with other types of inflammatory arthritis such as juvenile idiopathic arthritis and the seronegative spondyloarthropathies.
Objective MS2.10: Inflammatory Myopathies. Compare and contrast the pathogenesis, epidemiology, and clinicopathologic features of inflammatory myopathies.

Learning Goal 3: Congenital Disorders of the Musculoskeletal System
Apply knowledge of histology, development, and biological and molecular alterations to discuss clinical presentation, morphological appearance, and natural history of congenital disorders of bones, joints, and skeletal muscle.
Objective MS3.1: Muscular Dystrophies. Compare and contrast congenital muscular dystrophies due to dystrophin mutations to include the inheritance pattern, clinical progression and prognosis, and histologic changes to muscle.
Objective MS3.2: Skeletal Dysplasias. Describe the pathogenesis, including genetic mutations, and clinical and radiologic findings associated with skeletal dysplasias to include achondroplasia, osteogenesis imperfecta, and osteopetrosis.

Topic: Nervous System-Central Nervous System (NSC)
Nervous system disorders resulting from abnormal development, genetic mutations, vascular changes, immune mechanisms, infections, neoplasms, and intrinsic disease as they relate to CNS abnormalities are enumerated.

Learning Goal 1: CNS Neoplasia
Apply knowledge of the pathological and molecular basis of common brain tumors to describe their clinical behavior, morphology, effects on the nervous system, and therapies.
Objective NSC1.1: Clinical Features of Brain Tumors. Explain the pathophysiology underlying the signs and symptoms associated with brain tumors.
Objective NSC1.2: Classification of Brain Tumors. Compare and contrast the common types of brain tumors with respect to their location, age incidence, pathogenesis, molecular basis, morphology, and prognosis.
Objective NSC1.3: Hereditary Tumor Syndromes. Describe the major hereditary tumor syndromes of the CNS, the genes responsible for each syndrome, and the spectrum of tumors associated with each syndrome.
Objective NSC1.4: Grading of Brain Tumors. Explain the pathophysiologic basis for grading primary brain tumors and discuss how grading relates to prognosis and governs patient management.
Objective NSC1.5: Complications of Brain Tumors. Describe several complications of brain tumors and give specific examples.
Objective NSC1.6: Tumors Metastasizing to the CNS. Discuss tumors that commonly metastasize to the CNS and describe the locations in which metastases may be seen.

Learning Goal 2: CNS Infection
Apply knowledge of clinical features, neuroimaging studies, microbial pathogenesis, and location of lesion(s) to develop a differential diagnosis for CNS infections. Objective NSC2.4: Suppurative Meningitis and Abscess. Describe the gross and microscopic features of acute suppurative meningitis and brain abscess and name the organisms most commonly associated with each.

Learning Goal 3: Spinal Cord Disorders
Apply knowledge of neuroanatomy, pathogenesis, and biologic behavior to develop differential diagnoses and determine appropriate therapy for disorders of the spinal cord.

Learning Goal 4: Motor Neuron and Neuromuscular Disorders
Apply knowledge of genetic, clinical, anatomic, and neuropathologic principles to the diagnosis of neuromuscular disorders.

Learning Goal 5: Dementia
Apply knowledge of structure and function and general pathologic concepts to describe disorders in which dementia is a component.

Learning Goal 6: Demyelinating Disorders
Apply knowledge of the structure and function of the brain and general immunopathology concepts to summarize disorders that result in demyelination in terms of their etiology, pathogenesis, clinical and morphologic features, natural history, and therapeutic options.
Objective NSC6.1: Autoimmune Mechanisms in Multiple Sclerosis. Describe the autoimmune mechanism mediated by CD4-positive T cells that react against self-myelin antigens in multiple sclerosis and outline the clinicopathologic features of the disease.

Learning Goal 7: Ischemia of the Brain
Apply knowledge of the structure and function of the brain and general pathology concepts to discuss disorders resulting from altered blood supply and hypoxia to the brain. Objective NSC7.4: Hypertensive Hemorrhage. Describe the mechanism of hypertensive hemorrhage and name common locations in which this occurs.
Objective NSC7.5: Embolic Infarction. Describe how embolic infarcts differ from atherothrombotic infarcts in pathologic appearance and name 3 sources of emboli.
Objective NSC7.6: Acute Versus Chronic Brain Injury. Compare and contrast the gross and histopathologic appearance of acute versus remote brain infarction.

Learning Goal 8: CNS Response to Injury
Apply knowledge of normal histologic findings to describe changes resulting from injury to the brain and spinal cord. Outline genetic metabolic disorders affecting the CNS such as neuronal storage disorders and leukodystrophies with discussion of the abnormal process, cell/structure affected, inheritance pattern, clinical findings, and prognosis.
Topic: Nervous System-Peripheral Nervous System and Eye (NSP) Nervous system disorders resulting from abnormal development, genetic mutations, vascular changes, immune mechanisms, infections, and intrinsic disease as they relate to peripheral nervous system (PNS) and ocular abnormalities are enumerated.

Learning Goal 1: Peripheral Nerve Disorders
Apply knowledge of the structure and function of the peripheral nerves and general pathology and microbiology concepts to discuss peripheral nerve disorders. Objective NSP1.4: Leprosy. Compare and contrast the pathogenesis, clinicopathologic features, and complications of tuberculoid and lepromatous leprosy.

Learning Goal 2: PNS Neoplasia
Apply knowledge of the pathological and molecular basis of common PNS tumors to describe their clinical behavior, effects on the nervous system, and therapies.
Objective NSP2.1: Hereditary Tumor Syndromes. Describe the major hereditary tumor syndromes of the PNS, the genes responsible for each syndrome, and the spectrum of tumors, including the histology associated with each.
Objective NSP2.2: Tumors of the PNS. Compare and contrast the common benign from malignant PNS tumors and outline their molecular basis and clinicopathologic features.

Learning Goal 3: Ocular Disorders
Apply knowledge of the structure and function of the eye and general pathology concepts to discuss common ocular disorders.

Topic: Autoimmune and Multisystem Disorders (AIMS)
Autoimmune and other disorders affecting multiple potential organ systems are enumerated.

Learning Goal 1: Autoimmune and Multisystem Disorders
Apply knowledge of principles of immunology and cell injury and the pathogenesis of autoimmunity to explain the pathogenesis, clinical manifestations, and therapeutic interventions associated with autoimmune and other disorders affecting multiple organ systems.

Diagnostic Medicine and Therapeutic Pathology
Diagnosis and patient management require the student to apply their knowledge of disease mechanisms and organ system pathology to achieve efficient and effective use of clinical and anatomic laboratory testing. In addition, the student should learn the proper use of blood/ blood product utilization to enable optimal diagnosis, treatment, and patient care. There are 10 topics within this competency area. Each topic includes general learning goals and specific objectives that medical students should be able to meet upon graduation from medical school. Table 3 lists the topic areas and shows the number of goals and objectives for each.

Topic: General Principles (GP)
Every physician should have an appreciation for the preanalytical, analytical, and postanalytical phases of laboratory testing. In addition, physicians need an appreciation of the statistical treatment of data that underlies test utilization. This includes, but is not limited to, the ability to choose the correct test to make a diagnosis and facilitate treatment selection and to employ the appropriate testing paradigm to monitor patients with chronic diseases, enabling optimal clinical management.

Learning Goal 1: Laboratory Tests
Apply knowledge of clinical medicine, pathology, and statistics to determine the utility of a laboratory test in making a diagnosis and in monitoring chronic disease management. Explain the interpretation and limitations of clinical laboratory assays.
Objective GP1.1: Laboratory Errors. Discuss, with examples of each, differences among preanalytical, analytical, and postanalytical mistakes that lead to laboratory or diagnostic errors.
Objective GP1.2: Sensitivity and Specificity. Evaluate the quality of an assay in differentiating disease versus non-disease states, including graphically presenting and interpreting the data. Determine the relationship between sensitivity and specificity for an assay. Objective GP1.4: Reference Intervals. Describe the methods and statistics used to establish reference intervals; the effect of demographics, treatments, or disease states on reference interval variability; and the difference between reference ranges and therapeutic ranges. Objective GP1.6: Turn-around Time. Compare and contrast appropriate uses of "stat" and "routine" test priorities with discussion of critical values and the elements of "turn-around time." Predict which elements affect turn-around time the most.
Objective GP1.7: Regulatory Issues. Explain the basic differences between Food and Drug Administration (FDA)-approved tests and laboratorydeveloped tests, including Clinical Laboratory Improvement Amendments waived and non-waived tests and discuss the primary regulatory issues involved in physician-office laboratories, home testing, and provider-performed microscopy.
Objective GP1.8: Point-of-Care Testing. Explain how "point-of-care" (POC) testing in the physician office, multispecialty clinic, and hospital can enable better patient and population management of acute and chronic disease and why values generated using POC methods could differ from values generated in a high-throughput laboratory.
Objective GP1.9: Test Utilization. Discuss a laboratory testing decision tree to make a diagnosis for a patient with a chronic disease or a protocol for monitoring such a patient, the use of appropriate testing and the impact on healthcare cost for overutilization or underutilization of laboratory testing, and the potential impact on cost.
Objective GP1.10: Test Economics. Compare and contrast the cost of several common laboratory diagnostic tests and discuss the difference between the cost of a test and the charge to a patient.
Objective GP 1.11: Pathologists as Clinical Consultants. Describe the roles the pathologist plays to communicate among the laboratory, patients, and members of the health care team.

Topic: Health Informatics (HI)
Every physician needs an understanding of the role informatics plays in healthcare delivery and outcomes.

Learning Goal 1: Health Informatics
Apply knowledge of clinical medicine, medical records, laboratory medicine (diagnostic tests), computer science, statistics, and data analysis to improve healthcare delivery and patient care.
Objective HI 1.1: Informatics. Define informatics, contrast it with information technology, and discuss how different types of informatics are used to improve healthcare.
Objective HI 1.2: Data Analysis. Outline how data acquisition and analysis, including data mining and machine learning, can improve healthcare delivery and improve patient outcomes.
Objective HI 1.3: Laboratory Medicine Informatics. Describe the role laboratory information systems play in laboratory operations and in healthcare delivery.
Objective HI 1.4: Telepathology. Discuss the circumstances in which telepathology can be used as a diagnostic modality and describe its advantages and limitations.

Learning Goal 2: Artificial Intelligence (AI)
Apply knowledge of computer hardware, search engines, data analytics, and machine learning to the delivery of healthcare.
Objective HI 2.1: AI. Define AI and discuss different types of AI tools that can be employed in patient care.
Objective HI 2.2: AI in Pathology. Outline how AI can be used to enhance laboratory operations and to improve clinical decision making by providing focused diagnostic information to the clinical team.

Topic: Transfusion Medicine (TM)
Every physician needs an understanding of transfusion medicine, which encompasses the transfusion of RBCs, platelets, and plasma products in order to correct deficiencies in patients or remove offending antibodies.
Transfusions are not without risk, and knowledge of the pathophysiology of the disease and risks of transfusion are vital for physicians for optimal patient outcomes.

Learning Goal 1: Concepts of Blood Transfusion
Apply knowledge of pathology, hematopoietic cell physiology, and immunology to explain concepts of blood component transfusion and the therapeutic interventions in transfusion medicine.

Topic: Hematology (H)
Every physician needs a thorough understanding of one of the most common tests ordered from the laboratory, the complete blood count (CBC). Differentiating tests needed for diagnosis and treatment of anemia and coagulation disorders is important for appropriate treatment and monitoring of these disorders.
Apply knowledge of biochemistry, pharmacology, and pathology to describe the basic cellular and molecular events associated with blood coagulation and explain laboratory tests for the diagnosis and management of coagulation disorders. Objective H2.8: Platelet Inhibitors. Explain the action and the clinical use of common platelet function inhibitor drugs, including, but not limited to, aspirin and clopidogrel.
Objective H2.9: Anticoagulants. Explain the actions and clinical use of commonly used anticoagulants, including warfarin, the heparins, and the oral direct inhibitors of thrombin and factor Xa.

Learning Goal 3: Mechanisms of Anemia
Apply knowledge of RBC structure/function and nutrient metabolism, the mechanisms of anemia, and the clinical and pathological features of common causes of anemia to develop an appropriate differential diagnosis.

Learning Goal 4: Diagnosis of the Anemic Patient
Apply knowledge of RBC structure/function and nutrient metabolism, the mechanisms of anemia, and the clinical and pathological features of common causes of anemia to develop an appropriate differential diagnosis of anemia. Topic: Chemistry (CHEM) Every physician needs to be able to differentiate among multiple different chemical tests in order to narrow differential diagnoses, confirm a diagnosis, or to follow disease progression. To treat patients appropriately, physicians need to understand the appropriate use of major clinical chemistry tests, the limitations of their use, and the pathophysiologic changes that produce alterations in their values.

Learning Goal 1: Pathogenesis, Diagnosis, and Treatment of Common Disorders
Apply knowledge of clinical chemistry and physiology to discuss the role of chemistry testing in the laboratory in the diagnosis and management of common disorders and to describe how the pathophysiology of disease is reflected in abnormalities in results of chemistry tests.
Objective CHEM1.1: Thyroid Function Tests. Discuss the efficient use of laboratory tests to identify and manage patients with thyroid disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.2: Cardiac Disorders. Discuss the efficient use of laboratory tests to identify and manage patients with cardiac disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.3: Endocrine Disorders. Discuss the efficient use of laboratory tests to identify and manage patients with endocrine disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.4: Liver Disorders (Gastrointestinal Disease is moved to C3 CHEM1.9). Discuss the efficient use of laboratory tests to identify and manage patients with liver disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.5: Renal Disorders. Discuss the efficient use of laboratory tests to identify and manage patients with renal disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.6: Lung Disease. Discuss the efficient use of laboratory tests to identify and manage patients with lung disease, to define the pathogenesis of these disorders, and to help distinguish among diseases in a differential diagnosis.
Objective CHEM1.7: Toxicology. Outline the value of testing for drugs and toxins, accounting for the routes of administration, distribution, and metabolism of the agent of interest and including the specimen source, the analytes to be detected given the medical questions, and the timing constraints for specimen collection.
Objective CHEM1.8: Cancer Diagnostics. Discuss the appropriate tests for specific cancer diagnostics, including tumor markers and serum monoclonal protein analysis.
Discuss the efficient use of laboratory tests to identify and manage patients with gastrointestinal disorders, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM 1.10: Muscle, Nerve, and Bone Disorders. Discuss the efficient use of laboratory tests to identify and manage patients with muscle, bone, and nerve disorders; to define the pathogenesis of these disorders; and to help distinguish among diseases in the differential diagnosis.
Objective CHEM 1.11: Prenatal Disease. Discuss the efficient use of clinical chemistry tests to identify and manage patients with prenatal disease, to define the pathogenesis of these disorders, and to help distinguish among diseases in the differential diagnosis.
Objective CHEM1.12: Diabetes Testing. Discuss the efficient use of laboratory tests to diagnose and manage patients with diabetes mellitus, to define the pathogenesis of this disorder, to determine risk of development, and to monitor the disease process.
Objective CHEM 1.13: Therapeutic Drug Monitoring. Outline the value of testing for therapeutic drugs, accounting for the routes of administration, distribution, and metabolism of the agent of interest and including the timing constraints for specimen collection.

Learning Goal 2: Multisystem Panel Testing
Apply knowledge of chemistry and physiology to discuss the utility of panel testing in the laboratory in the diagnosis and management of common disorders and to describe how the pathophysiology of disease is reflected in abnormal results of chemistry tests.
Objective CHEM 2.1: Basic and Comprehensive Metabolic Panel. Outline the components of the basic and comprehensive metabolic panels and describe their advantages and disadvantages as screening tests.
Objective CHEM 2.2: Lipid Panel. Outline the components of the lipid panel and identify and describe how this test is used to diagnose and manage patients with lipid disorders.

Learning Goal 3: Urinalysis and Body Fluids
Apply knowledge of normal chemical and cellular contents of urine, cerebrospinal fluid, and body cavity fluids in the diagnosis and management of common disorders and describe how the pathophysiology of disease is reflected in abnormal results of fluid tests.
Objective CHEM 3.1: Urinalysis. Discuss the advantages and disadvantages of routine urinalysis and describe how particular abnormalities can help in the diagnosis and/or monitoring of specific diseases.
Objective CHEM 3.2: Body Fluid Testing. Discuss the role of examination of effusions in helping to elucidate their causes.
Objective CHEM 3.3: Cerebral Spinal Fluid (CSF) Testing. Outline the components of spinal fluid testing and describe how this test is used to diagnose and manage patients with CSF disorders.
Objective CHEM 3.4: Blood Gas Analysis. Discuss the components of a blood gas panel and describe how these tests are used to manage patients, particularly in the intensive care unit or in the surgical setting.

Topic: Immunology (IMM)
Every physician needs an understanding of specific laboratory tests to differentiate between inflammatory and immune-mediated diseases. Many newer techniques have been recently implemented that allow more definitive diagnosis and specialized treatment for these disorders.
Learning Goal 1: Pathogenesis, Diagnosis, and Treatment of Immunologic Disorders Apply knowledge of immunology, biochemistry, and pathology to describe the basic cellular and molecular events associated with immune system diseases of specific tissues and organ systems and the use of laboratory tests to diagnose and manage these diseases. Topic: Molecular Pathology, Genomics, and Cytogenetics (GE) Every physician needs an appreciation of the complex fields of molecular pathology, genomics, and cytogenetics, the ever-evolving molecular techniques that are essential for diagnosing diseases as accurately as possible, and the many diseases correlated with specific targeted immunotherapy or chemotherapy to maximize effectiveness of treatment, decrease side effects, and optimize patient survival.

Learning Goal 1: Genes
Apply knowledge of genetics including the structure and organization of the human genome and regulation of gene expression, genetic variation, and inheritance patterns to basic disease processes. Objective GE1.9: Cytogenetics. Define the following cytogenetic terms and nomenclature: karyotype, euploidy, aneuploidy, monosomy, trisomy, deletion, ring chromosome, inversion, isochromosome, translocation, balanced reciprocal translocation, and Robertsonian translocation.

Learning Goal 2: Chromosomal Disorders
Apply knowledge of genetics to explain the molecular basis of single-gene and non-neoplastic chromosomal disorders.
Objective GE2.1: Testing for Genetic Disorders. Describe, with disease examples, how laboratory tests are used to diagnose the following specific genetic disorders: Mendelian disorders, autosomal disorders (dominant and recessive), X-linked disorders, chromosomal disorders, and disorders of nonclassic inheritance.

Learning Goal 3: Genetic Basis of Neoplasia
Apply knowledge of genetics to explain the genetic basis for neoplasia and the role of genetic testing in diagnosis and treatment of diseases. Objective GE3.5: Genome Testing. Compare gene panel sequencing, whole exome sequencing, whole genome sequencing, and transcriptome sequencing with respect to the information gained from each, cost, and turnaround time and discuss clinical situations in which each might be appropriate.
Objective GE3.6: Chromosomal Alterations. Compare and contrast techniques used to identify structural or numerical alterations in chromosomes and discuss how these can be used in the diagnosis and monitoring of patients with neoplasia.

Learning Goal 4: Reproductive Genetics
Apply knowledge of genetics to explain the role of reproductive genetics and population screening.
Objective GE4.1: Carrier Testing. Describe the role of preconception and prenatal carrier testing for genetic disorders depending upon family history and ethnic background.
Objective GE4.2: Newborn Screening. Describe the rationale for newborn screening for genetic diseases and explain the difference between screening and diagnostic testing.

Learning Goal 5: Diagnosis, Treatment, and Counseling
Apply knowledge of genetics to explain the role of genetic testing in diagnosis and treatment of diseases and in counseling of patients and families.
Objective GE5. Objective GE5.5: Inherited Diseases. Discuss the approach used for establishing the diagnosis for inherited diseases, directing therapy, and optimizing cost effective care.

Topic: Autopsy (AU)
Autopsy is a division of anatomic pathology that encompasses the examination of a deceased person, either for medical or legal reasons. Understanding the value of the autopsy, both for scientific investigation of potential inherited disorders and for understanding the diseases that led to a patient's demise, will allow physicians to appropriately discuss this end-of-life medical evaluation.

Learning Goal 1: Value of the Autopsy and Obtaining Consent
Apply knowledge of clinical medicine, quality management, and medicolegal issues to discuss the value of the autopsy and procedures for obtaining permission.
Objective AU1.1: Value of the Autopsy. Provide examples demonstrating the value of the autopsy toward improvement in clinical diagnosis and management, quality control, medical education, research, and elucidation of "new" diseases.
Objective AU1.2: Consent for Autopsy. Discuss the general process to identify the legal next of kin or individual authorized to consent for an autopsy.
Objective AU1.3: Obtaining Consent from the Family. Describe how to approach a family to request consent for an autopsy, including a discussion of the autopsy procedure in language that the patient's family can understand.
Objective AU1.4: Professionalism in the Autopsy. Discuss the psychosocial-emotional aspects of the autopsy experience, including its role in closure, and the importance of communication and professionalism among the healthcare team.
Objective AU1.5: Anatomic Findings in Autopsy. Describe the role of the autopsy in identifying dysmorphology and anatomic abnormalities to help diagnose and classify congenital disorders.

Learning Goal 2: Death Certificate
Apply knowledge of quality management to discuss the utility of death certificates and proper approaches for completing them.

Learning Goal 3: Forensic Autopsy
Apply knowledge of clinical medicine and postmortem examination to discuss the indications for medical examiner referral and special procedures in the forensic postmortem examination.
Objective AU3.1: Role of the Medical Examiner. Define the role of a medical examiner in terms of public health and protection of legal rights and describe differences between a forensic and medical autopsy.
Objective AU3.2: Reportable Deaths. Identify circumstances of death that need to be reported to the medical examiner/coroner.

Topic: Surgical Pathology (SP)
Surgical pathology is the area of anatomic pathology where all tissues or hardware removed from a patient are evaluated. Specimens sent to surgical pathology may range from minute endoscopic biopsies to large limb resections. Special techniques are commonly used by pathologists in evaluating these specimens that allow for definitive diagnosis and the recommendation of appropriate treatment for both benign and malignant lesions.

Learning Goal 1: Role in Diagnosis
Apply knowledge of clinical medicine and pathology to describe the role surgical pathology plays in diagnosis and treatment of benign and malignant disorders. Use specific examples from the most common diseases and forms of cancer.
Objective SP1.1: Specimen Types. Distinguish biopsies and excisions, describe the circumstances in which each is appropriate, and discuss the different types of information obtained from each type.
Objective SP1.2: Differential Diagnosis. List the major differential diagnoses for a surgical pathology specimen obtained from a lesion or mass in a particular location, and describe appropriate further studies to resolve the differential.
Objective SP1.3: Special Studies. Describe how a pathologist uses fresh, fixed, and frozen tissue for histochemical and immunohistochemical stains and genetic testing to arrive at a diagnosis, provide prognostic information, and direct specific therapy.
Objective SP1.4: Staging. Describe the information that the pathologist obtains from a resected tissue specimen, how this information is reported, how it is combined with clinical information to stage the tumor, and how staging information is used to guide treatment.
Objective SP1.5: Frozen Section. Explain the use of frozen sections and how the pathologist works with the patient care team to optimize and prioritize diagnosis and patient management.

Learning Goal 2: Immune and Infectious Diseases
Apply knowledge of clinical medicine and pathology to describe the roles surgical pathology plays in diagnosis and treatment of inflammatory disease, in particular those with immune or infectious etiologies.